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But it's a really nice introduction and it's great to be here because I really enjoy everything that Black medics have been doing and are consistently doing. So, we'll get into this. Um I'll just introduce the aims of this presentation really. So we just want to explore how implicit bias is within the educational field can impact clinical output and research as well as presenting a bit of an overview of the active mechanisms that I've been trying to do. But it's not just myself, I've got a, a massive team of um very proactive colleagues who are all trying to diversify and engage the curriculum in a new way basically within lots of different modules. So just a bit about me, everything that I've done is all musculoskeletal. I feel like sometimes that's the part of anatomy that people find quite challenging. Cos there's a lot of things to learn in a really small place, but that's my topic of interest. So I'm a proet orthotist. I've worked in Oxford, London and Lincolnshire and Nottingham now actually. Um and I'm a MP my protein personal trainer as well. So for those who are not completely aware of prosthetics orthotics prosthetics is the replacing of limbs. So, the, er, the little foot that you've got down there at the bottom, whereas the orthotic slide is all about exoskeletons and facilitating movement. But based on, you know, the human body and what is currently there. So we're gonna sort of relate that into this aspect of diversifying the curriculum here. I'm gonna ask you to scan this first of all and, and there's the code as well. So if you could just jump onto this meter and um just answer that first question, what is implicit bias? What does it mean to you? Maybe just drop a couple of words into the chat and see I will put the link into the chat as well for everybody. Hopefully that's gone through, right? And just because of the way this is um working, I have to read out some of the answers that we'll get off of this minty. So, so far I've got stereotypes, preconceived notions as well. Nonexplicit bias, noninclusion. Yeah. All good. I'll leave it up just for a little bit and let's see what else comes up here. Perfect. So things that may not be intention, intentional, non explicit bias. Noninclusion. Brilliant. OK. So this is a definition of implicit bias. OK. So it's in the subconscious feelings, attitudes, prejudices, stereotypes, an individual has developed and that's due to prior influences or imprint, imprints throughout their lives. And I think this is the key bit, right? Individuals are unaware that subconscious perceptions instead of facts and observations affect their decision making. Now, being in a role now where I am an educator and able to influence the resources and the information that we draw into the curriculum makes the last sentence extremely important. And what I've been able to do and what I encourage everybody to do is sort of reflect on their journey as they go through different parts of their education and life at all. And so when I look back and I'm like, what was the educational process like? When trying to get into prosthetics and orthotics? There's a lot of things that are different than to now. And when we think about implicit bias, there are loads of different points along our patients journey where that can impact. And so I've pulled this from Scotland, NHS actually NHS five. And when you look at it, you think, OK, so you've got check in triage treatment outcome, how many different people have you interacted in that period of time? And therefore how many different episodes of implicit bias will make their way into that patient's outcome um and impact their journey, basically impact recovery diagnosis, all different things like so, so it's huge and it's, it's extremely relevant for us to focus in on that and for everyone to reflect on their own implicit bias in this matter. So I'm gonna draw you into the world of feet. I know everybody, not everybody's uh super excited to look at feet, but it's the one thing that II tend to do a lot. Uh I'm gonna take you with me on this. And so if you could just jump back on to that ment, then can you just let me know, what do you know about flat feet? So the answers here are just like I am very familiar. I know nothing at all. Maybe, you know, a little bit but you need a refresher. OK. Nice. OK. All right. So we've got, we've got quite a few people who are very familiar. I like that. That's fantastic. But also we've got the equal amount of people who are not familiar at all. So this is a, a nice example. I'm just gonna say a couple of things on it then. So when you think about feet and this is how it was always described to me, right? And this is actually sometimes what still happens in some of the curriculum from the, the people that I speak to. So feet are usually classified into three different elements. You've got normal, you've got flat foot and you've got high arch and the first image that you can see on your left. So the one with the green imagine that you are stepping into sand and it's the imprint that you're basically leaving there. OK. So high arch, there is less of an imprint sitting inside of the, of the middle of the foot. Whereas the flat foot, there's literally no air gap is, is what it's showing here. And then on our right hand side, these are actually anatomical models that well, um, the, the manufacturers put out. Now, I don't know whether you've probably seen these inside a dissection hall or even inside clinic. Often in physiotherapy rooms, loads of different places. Ok. But ultimately, not only are these student facing, but they're also public facing, I'm sure you are aware of those running shops. And I know sports director used to do it where you would stand on something and they'd tell you, ok, we recommend that you get a, you know, a high arch shoe or a neutral shoe or something like that. And the thing is that people really profit off of this, OK? And off of these diagrams specifically and for people who are unaware or even people who are aware of the issues with feet, if this is what we're basing things off of, there is a bias element and I will come to it and there is a actual very real case study that I'm gonna present as we go through this. Now, what we're usually told is if we have a flat foot and if there's pain, I should say, then we would prescribe an insole. OK? And the whole idea is that we're trying to get back to this normal foot posture, this normal foot alignment. OK. Right. So I'm just gonna put a little pole into the chat and I'm gonna ask you who has flat feet? Is it number one or is it number two? Ok. There we go. Ok. So I've got everybody is saying number one. Ok, nice. Oh, we have one person who said number two on that one. Ok, brilliant. I'm gonna do this again. Now bear with me as I type. So who has flat feet? Number one or number three? Ok, let's let's have a look. So what has everybody said? Everybody said? So we've got 16% for number one and we have 83% of you for number three. OK. All right. Let's have a look at the next thing then. So now that you've got number 12 and three sitting together based on the information that I gave you before and us thinking about those arches. Um I can understand why everybody said number two, however, clinically and anatomically, this is what we should be looking for. Now, is this navicular bone, I'm sure you can reach down behind your foot and if you run it along the medial side of your foot, then you will feel a nice bony bridge. Ok. Um And that is a navicular bone and that's the point where we, we start to look at arch height. It's not as simple as that, we need to normalize and quantify it to foot length. But effectively that now if we look at number two and number three, I can tell you that foot, number two doesn't actually have a low arch. What it does have is a greater amount of soft tissue, a higher volume of soft tissue between that navicular and the floor. Ok. So actually, um from a clinical scenario and obviously, I've only given you one viewpoint for this, I'd probably be going for number one sitting on the end over there. So, like I said, number two, it just got more soft tissue, more mass inside of the arch at that point. Now, that is a really interesting concept because if we go back to our diagrams which are effectively given to students to public, that's not what we're seeing here. OK. So already we're starting to form this bias sitting in our head as to I know what a flat foot looks like. And I've said to you already that if you have that flat foot, then what we'd do is be giving you an arch support, right? So effectively, what everybody said to me is that we would be going to give the arch support to patient number two. No. So 0.1. OK. Of, of this little talk here is that we need reference points to help us to determine the scale. And that's not just for feet. OK? We can put that into context with other things in, in terms of, you know, if we keep this to Black Medics Black History Month, we all know about dermatological conditions, skin conditions and the fact that turn varies, things will look different and what we try to do in our heads to help us understand and to develop that clinical reasoning is to create this scale. But that scale is gonna be dependent on observational differences based on experience. It could be based on stories. I've got this little thing down here. Maybe you've heard like flat feet, people were not allowed to join the army. Maybe that's something that sort of, you've, you've understood more about um you may be influenced by social media. I know that maybe because of my Google history, I get a lot of things like this. But um they always pop up and they try to like, tell you maybe you need to go and see this person or buy this thing, et cetera, et cetera, or maybe you are sort of embedded in the anatomy a little bit more. But in terms of anatomical difference is what we can, what we see and what we know is that there are differences in the plantar thickness on the bottom of the foot and that there is variation in terms of the morphology of the bone. That's the shape, that's the size of the bone. OK. All things which are extremely interesting. So what I'd like you to do is jump back onto the ment meter for me and I'd like you to look at these two images and based off what I've said, can you identify two discussion points between image one and image two and you're looking at it as if you're a student or as public facing either way, is there anything with the images that you can see that brings about bias in any respect? OK. I, like I said, because I can't share them to you. I will read it out to everybody. So we've got white skin tone is one of them. Is there anything else that anybody wants to add in skin tone? Again, the footprint is not accurate? Yeah. Based off of the foot versus the bones, white skin, no variation. There's only three. I really like that answer. That's a fantastic answer in terms of of the scale. Yeah. OK. So I've got four people mentioning skin tone and actually let's let's touch on that first. I kind of predicted that could have been one of those. So skin tone. OK. And the implications of this, I'm sure you have thought about this and you would have heard about it in a lot of places now. Um even Asia's chap who was our student who did the very first of this within this um color in the clinic series mentioned skin tone quite a lot, the implications of representation in that, in that aspect. So yeah, so skin tone and it is very impactful if you're sitting in a clinic and then as a clinician, you pull something out and you're thinking, well, that's, it's not my fault. So, yeah, definitely. But the other thing that I wanted to mention and actually nobody's picked up on just yet is language. Now, I know that's maybe it's quite small on your screen there. But if you think about the arch type, what we're basically saying is this is a normal foot, OK. That is what a normal foot should look like. So if we were to go off of the basis here, then the foot that we mentioned previously, number three, that even though it actually had a, a regular sort of um posture, it was not normal. OK. So I think that there's an essence here where implicit bias is not just about that visual representation that we see, but it's very much about the language that we're using the language that we're projecting towards students, towards other healthcare professionals and also towards the towards the public. OK. Yeah, I kind of just summarize this but let's say it again. So the way information is presented to us will impact how we accept store and challenge this information. Uh And as an educator, healthcare professional, it's important to introduce representation from a very early stage and to challenge it as we go through. So this means that if I was back at uni now studying prosthetics orthotics or something like that, I would expect to be seeing these different skin tones based in clinic, I would expect the language to change. But also as a student, I would hope that educators create an environment where I'd be able to challenge that language myself and say, OK, so why, why are we using this term normal? OK. And how do we deviate either side of that scale? What is the definitive? So in terms of visual representation, and then I mentioned it as she was introducing me. But when I was in Sheffield my whole research project, my whole thesis was about representation. OK for star students. But also because it was a master's program for soon to be educators, there was a very unique role that they were able to have. So this work was presented at the Anatomical Society. It was a qualitative and quantitative study, basically assessed the imagery that was used within the curriculum. And actually we did it across all different sectors, not just M SK but across everything. Um And what we noted is that of course, there was a lack of representation. OK? This was 2021 things have changed now with 2024. Um And like I mentioned, Asia's gone on to do bigger and better things. I mean, absolute credit to her. And I'm able to use that myself in terms of integrating new images into the the powerpoints into the actual lab settings where we are now. And it has had a massive impact. Students have been able to, to visually see a difference there. But it's not just like I said, it's not just about skin tone. It's also about being able to just visualize these differences. OK, anatomical differences. And I found that that was something really interesting because through the work that I've done as a supervisor, students always mention skin tones, skin conditions sort of thing. But actually, as educators, everybody was mentioning anatomical variations and it's such an interesting topic. I mean, this is one of the reasons why we do a lot of dissection work is so that we can assess and see these anatomical variations. It's exciting, but it's so informative at the same time. And I just wanted to present a couple of things to you actually. Um So here are a few anatomical variations which are based off of race and ethnicity. So you've got and they, and all my references are at the end, I'm very happy to share them with anybody who has um questions or anything like that. But effectively, there's differences between race and ethnicity in terms of craniofacial fat distribution, muscle mass composition, tooth structure, organ size, long bone morphology. That's a huge amount of variation. And I think we owe it to ourselves to say that the population is really mixing, OK, there's loads of different mixes all over. So in terms of now trying to read this research and categorize people back into those different ethnic groups. It becomes very, very challenging, but it is something that I think that we need to be aware of and being inside a clinic we need to be aware of it. The issue that arises is that when we think about visual representation, there is a big message that comes alongside it and it's actually the, the context of it, which is important. And I'm, I'm gonna come back to that. I just thought that this was really interesting um for those uh anatomists and just for anybody who's really interested because it, you know, it's all M SK studies actually show that the Palmaris Longus and feel free to do this as well and see whether you've got Palmaris Longus. Um but there is a variation or difference between populations, er which yeah, with the least they say within African populations. But again, this is a 2016 study and I'll come back to, to being able to look at research and, and critique the research and try to see how you interpret it in terms of race, ethnicity, clinical diagnosis. OK. So we are aware that there are differences between people, of course, um we're in this world now where we need to recognize difference but also not make the difference, the biggest thing to talk about because then that would be, you know, sometimes it comes across as, as too much so effectively, we have this question, right? How do we identify the differences between anatomical variation without drawing on racist pseudoscientific theories? Let's touch on that a little bit more and here's the context. So when we're thinking about pseudoscientific theories. It's cat categorizing race based on physical traits. Now take yourselves back to the slave trade. This is very topical because it's Black History Month. But if we go back there diagrams caricatures black face, what were they trying to do? They were trying to create this comedy and whatever, but based on um emphasizing features, large feet, noses, lips, et cetera. The whole idea here was to, was to draw on the fact that the Africans that are slaves in that manner were biologically different. And the whole idea is that oh, you are biologically different, you look different, therefore, you are suited to labor, you are more primitive. OK? There was always this correlation between um slaves, apes, et cetera, et cetera. OK. So I think it's a very delicate way that we need to handle the fact that there are differences between races so that it's not then going into one of these pseudo scientific theories. And we really need to think about the context of the images. So what am I saying? Yes, we need and everybody mentioned there about skin tone. So yes, we need to show variation in skin tone. But the way the photos are shown are very important. For example, um If I were to just in one of my lectures display this without putting any definition underneath it, who who these people are, where they are their lifestyle, it could come across in a very racist manner. OK? So I think we just need to be sensitive to that effect. Um And that's why when we're showing things like this, we, we need to have that discussion element and it needs to, we need to create a safe space for students and for, you know, healthcare professionals, for all to be able to discuss it back and forth. And so I'm gonna take you back to the meter again and I'm just gonna ask you about implicit bias. OK? So when you, you get a patient coming into your, into your room and there is a whole process in terms of the assessment phase. OK. Assessment is super important. It's where we grab all our information from and just wanna find out from yourself at what point in that assessment phase should we really be considering implicit bias? And you can click more than one, right? So again, I'll just have a look at what you're saying. OK. So I've got a lot of people saying history taking, I can't disagree with you. Yeah, I'll just wait to see if there's any more answers that are coming in, but this is good. It's interesting. OK. All right. I'll leave it there. So actually the majority of people have said history taking, OK. They're saying that's when implicit bias should be recognized a lot. The next one after that was physical exam, it's kind of going down on the scale. So it was history taking physical exam. Let me move this one then clinical reasoning, then collaborative decision making and then documentation. And that's really interesting to me. Actually, I, I would, I wonder does any, excuse me, let me put a, let me put a poll just here. I just wanna find out. Did anybody put more than one? OK. Just click on that for me. Did you click more than one option? Yes. OK. So I would, I would challenge a lot of you then um when you're saying history taking as the most important, I think we definitely need to draw on the history of our patient. We need to find out. When did the pa when did the symptoms start? Was there an injury? Um What's the background? Um Yeah, like has any, does anything run in the family? And I can understand why you're saying that does anything run in the family. We're thinking about genetics, et cetera, et cetera, et cetera. But very honestly, I think the clinical reasoning and the collaborative decision making are key points in this chain where we need to be thinking about implicit bias. OK? Because you've gathered that information from your patient. Your reasoning is going to be the stage where you are identifying a diagnosis. Your collaborative decision making is the point where you say, OK, I've got a diagnosis. What are we gonna do in order to treat this person? And that is where you should really be thinking. Have I just made an assumption have I just drawn on some aspects of implicit bias and has anybody challenged me in this respect? And let me present this case study to you now? Ok. This is a true case study. It happened in London and it's quite for me. I mean, like I'm always shocked when I say it, but here we go. So it was a 14 year old with foot pain. Ok. And low arches, it was just a given. So 14 years old active in sports and was of African descent. So he came in with chronic foot pain. Ok. Um, but when I say chronic it was pain after activity, it went between five out of 10 to a little bit higher. Ok. Um, and it was mainly after sports and the initial assumptions and it wasn't myself in clinic. I'll say that first of all was that both parents had a family history of flat feet. They had quite wide feet. They had big, they had, yeah, they did, they had quite big, thick planted pads and the reason and maybe you think this is weird. But hold on a second. How does the clinician know this? Well, exactly. The clinician obviously is assessing. So, shoes and socks come off, right. But, um, they also said, oh, does this run in the family also? Let me see. Um, you know, assessed mum and dad had a look. Oh, yeah, it looks about right. Um, everybody's feet look relatively, you know the same something that we always do have to check muscle power. We think about tibialis, anterior tibialis, posterior, um, fibularis as well. These are like the, the common ones with, with flat feet es essentially. Um, and then basically it was written off as, oh, you're 14 years old, you've probably got some growing pains. You're quite active. Um, you'll be fine, essentially. What we'll do is you've just got some genetic fat feet here and here are some insoles rest and you'll get better. Ok. Well, so the scenario was this, ok? You've got pain, you've got a low arch, you put something in it, solves the pain. Hopefully, three months down the road, you can take it out and then you can continue your daily activities. What the clinician did not consider in this situation was that the thing that they'd prescribed was going to increase pain was going to cause more knee discomfort was going to create lower back pain and was going to reduce activity. Bear in mind, this is a 14 year old. Ok. All of that should like, I mean, that's huge red flags that's happening within a six week period. Anyway, uh, patient came back in and effectively increased foot pain and stiffness. Like I said, the knee pain and then the sort of the, during the routine activities is now where we're starting to get this pain, which is seven out of 10. So I happened to be the person to see them the second time in. It wasn't one of those where you, you follow up on the same patient. I just happened to, to take that clinic. Muscle strengths were five out of five. Based on, um, the previous advice the parents had bought new footwear, but it was wearing out very quickly on the inside. And essentially I said, well, this is not right, is it, it's, it's definitely not right. Like we shouldn't be getting that much pain based on putting something in which in our scenario, with flat foot should essentially ease things and reduce the amount of strain that's running through some of our musculoskeletal um structures. So I wrote back to the GP and requested an X ray and followed up on the X ray and essentially this boy had tarsal coalition. I don't know if anybody is aware of tarsal coalition. So I'll just, I'll just explained it to you really quickly. In fact, it's very interesting. Hopefully, you take this away as an interesting element of this all. So normally your tarsal bones are separated, um which is the left hand image. And if you look at the right hand image, you will see that the calcaneus and the navicular bone are actually fused together. Now, you've got seven tarsals and it can actually happen in any of the tarsal bones. OK. But essentially, when you've got this look, what happens is the foot ends up to look slightly flatter. Um and that's what happened. It can often be misdiagnosed. But I think the, it can be misdiagnosed with flat feet is what I should say. But the issue here is that there was that automatic assumption. Oh, the family have it, you know, African descent, you'll be fine. Put it away. There is nothing there and there, there was no need to do anything further in that journey. That, that was it that the insults would solve it. See you later. Um I think so the key learning point here is that sort of implicit bias of, oh, it's normal for him. Um And there's nothing wrong because again, it's normal for him. And do you remember I drew on that word normal from from earlier on and it's that um it's a very tricky word to use in this scenario. And if I think about the mental meter that everybody has popped in above the documentation stage, I would highlight that you should really consider implicit bias within that documentation phase because the way that you phrase things um and the way that other clinicians would be able to see it being passed on the way that patients are able to access GDPR data and everything, of course, um The way that things are written down in documents needs to be carefully considered and you should always be considering what is the the most suitable, the most professional way that I should be writing this. OK. So the assumptions due to race, ethnicity and stereotypes in this manner, actually negatively impacted the patient. And that's when things become quite scary, isn't it? And I think early on if you were potentially exposed to some of these scenarios and you had that safe space to discuss, then actually we could rule out some of these um indiscrete andies and some of the actually the dangerous behaviors that can take place within a clinical setting. Yes, I would say another thing just to add on to this. Um, I'm sure a lot of you have seen about this, but if you haven't, it's about that taking that pain seriously. Um, when, if you've got a child coming into you 14 years old, you know who's saying? Oh, my pain is about a five out of 10 or so. Are you thinking, is that just growing pains? Do we just assume that everything's gonna be fine? And, you know, next, I've only got 10 minutes to see each person so they'll be fine. Um, you know, it's not as much as like a, an eight out of 10. And it's again, something that we should consider, are we just because they have potentially got this thicker sole and in some situations? Yes, they do. That doesn't take, um, that doesn't change the fact that they're still very sensitive to pain and that we need to manage that pain for the individual, not just consider if the diagnosis is flat foot here and in. So you're done again, that can sort of be spread out into loads of different diagnoses within a clinical environment. OK. So here what we say in challenge biases, OK, we need to challenge them. And I think there's an element here where being able to challenge the bias is very dependent on the situation that you're in as an educator. Now, I'm trying to create environments where we can actually discuss and challenge things openly so that everybody can um can develop and can reflect on their own um implicit bias. So I guess 0.2 here then is is visual representation enough. And do we need to look further? So let me OK, just have a think about that. OK. I won't, I won't do another poem on that one. Just have a think that is, is visual representation enough. And if we do need to look further, what are we trying to do? And one thing that not just the NHS, but I'm sure loads of different health care um environments are like is evidence based practice. So when we think about evidence based practice, we're thinking research has been done. There's been a large group of people who have gone through this, this treatment or assessment or something, et cetera, et cetera. It's been vigorously tested and, and then there's a conclusion based on it which allows us to disseminate this into the clinical environment. Yes. And where do we go for that to the literature. OK. So if we keep to the foot theme, OK, there's a couple of things here that are really interesting. So racial differences in foot disorders and foot type. Um, and I've actually pulled these, these are just span a few. Ok. But actually this is within the past 20 years. One of them is 2004. The other one's literally just come out 2024. And let's look at some of the words that are sitting inside this. Ok. So there are significant racial and ethnic differences, independent of educational gender where if we look at the second one, we've got compared to Caucasians, African Americans, we're almost three times more likely to have pes planus, pes planus flat foot. Um I'm sure I I'm, I'm sure you're wondering sitting there thinking, oh, but why? Um there's also this was a really interesting 1, 2013. So they actually looked at a Malawian group to see the difference between plantar pressure and how they distribute forces across the bottom of the foot. And that was based on the fact that they are in different environmental settings, have different occupational settings as well. Um And how the anatomy is basically responding to these external scenarios, er, and look at the last one as well. So nonwhite and minority patients exhibit higher rates of foot and ankle fractures and worse functional outcomes. So what could influence this? I, so if you just jump back on to the, the ment meter for a second. Can you just throw up a couple of different words? What factors influence patient outcomes when we're thinking about these scenarios here? The fact that there are differences documented within the literature. What other facts influence that when you hear African Americans almost three times more likely to have pes planus. W what is the reasoning for it? Why would they have higher rates of foot and ankle fractures? Ok. So coming in now I've got anatomical variations. Y Yeah. Yeah, for sure. We've got diet. That's a fantastic one. Definitely social determinants. Yep, socioeconomic influences, environmental. Yep. Genetic. Absolutely. So that's just a you sitting inside there pain, not taken seriously for sure. Yeah. Exercise indeed. So we're thinking about again the socioeconomic um environmental aspect here and if we're really thinking about treating the patient and not just the diagnosis, then in terms of the real world, we need to be considering their chain, their sort of like immediate um influences on their health um and their personal wellbeing, which is going to, of course, factor in everything and in an ideal world, of course, we would be able to sit down with our patient and take a full history. Identify all their different factors. Have a massive list of genetic um predispositions or, or anything influence family and then have a very, very tailored program. The issue is it's, that's just not how it is. Um So you have to be able to ask the right questions in the right way to, to your patients basically. And that makes it really hard, doesn't it? Because like we mentioned before, where's the time? Especially for GPS? They've only got, you know, a couple of minutes to speak to each individual person? You don't get to know them, you don't understand the factors that are influencing them and effectively. Yes. Um How do we develop these opportunities is the part where I or where I'm trying to work on at this moment in time? So in terms of health care professional facing, OK, when I was in Lincolnshire, I created a local musculoskeletal forum and group. And the whole idea is to develop and re and and challenge not only our patient prescriptions but also to develop our own research skills. If we think about those research samples that I've just pulled out on the previous slide, we can argue um of course, sample size, our very favorite one, like how widespread does this information actually go. But also we can argue on um what were the like, what environmental factors considered? What people taken from the same occupation? Um Were people given, I don't know time to wear in insoles for the same period of time? Were, were conditions variable or were they constant there's loads of different things that we could put into it, but actually, it becomes really hard. And I think now being in this educator role and obviously student before, you don't get the time to sit down with research and actually depict it bit by bit and say, do you know what this piece of research is translational into this? And therefore based on that, I can take this going forward and I'm sure a lot of us do it. We read an abstract, right? And then you go down to the bottom of the abstracts and you check the results. But and you're like, yeah, the paper saying, OK, and I'll just take that forward. But actually, if we want to be real changes, and if we want to really address implicit bias, which is all over research, then we need to be critically running through those papers, finding the the critique and methods and all sorts of things and the interpretation of the results which has a massive means to impact our patient coming in. So what we did in these sessions and, and we're still doing these sessions. Although I'm not um at the forefront right now, cos I'm in this um in this teaching role is that once monthly, we have to present a patient, we have to challenge our colleagues on why they presented that prescription. And we'd have to read a paper which showed our evidence based practice and our reasoning for it, our clinical reasoning and that clinical reasoning, we then asked we or we tried to figure out all the implicit biases effectively and our own personal challenges that could have impacted that. And one of the things that we really did was it was never based off of, oh, that's what I did for another patient. Oh, that's what I saw in another patient's notes because that doesn't give us a strong enough reasoning for the prescription element. So instead we'd have to, um, and this is where clinical audit comes in. And I know that clinical audit can be so extremely long and challenging to do, especially when you're trying, like when you've got a 12 hour um when you've got 12 hour shifts, but um this is the point where you need to sit down together and really, really challenge that literature. So sorry, I've just seen that there was a couple of things in the chat. Um Don't worry about about that clicking is fine. So that's one thing that I would really encourage you to do. And at the moment, what I'm trying to do is to identify student groups that would like to be a part of this. And I really honestly think that starting earlier on when you're a student is the way forward because you guys are the change makers who can then go in and say, actually, I think we should do this. Actually, I'm gonna challenge you on this because I've seen this documentation and I know that you get opportunities to do B ed side projects and things like um you know, different projects and things like that. Um But marrying up the literature to actual clinical practice and interaction with patients is so different. So I think there's a a way there to empower. So anybody who wants to collaboratively work on that, I would be very happy for you to get in touch with me effectively. The other thing, of course, in terms of developing these opportunities and impact in our patient, trying to move away from just the diagnosis but treating the individual is this representation and open discussion. So we've mentioned that quite a lot today in terms of visual representation, anatomical variation uh and context there. And the last thing I wanna say is that I've embedded this into wider institutional policy. So I was a, a key member of the um the faculty Toolkit for diversity inclusion and drawing in on the fact that we need the representation that we need opportunities for this collaboration discussion was key here and I'll give you an example of that just now. So we have this History of Medicine Module and uh actually sorry, it's called History of Anatomy Module. And there's a lecture that I take on it, which is called History of Medicine. I took it over about two years ago or so. And I can't lie to you. It was very much White British um interaction with medicine. And so I thought I would challenge everybody here. Have you heard of Doctor Harold Moody? Um And you can just say yes or no to yourself. You don't have to worry about writing it anywhere. We won't do a poll. But effectively, this is what I'm trying to do with some of these lectures and seminars that we give now is to introduce a new person into, into this space with students and actually get them to, to do a little bit of research themselves and try to understand the legacy that they're leading things that have gone wrong as well and how we're taking that forward. So, Doctor Moody uh actually founded the league of, of colored peoples. And I know we don't use that in terms of a term at the moment. But it was again about the sensitivities and advocating for better healthcare services within those black communities in Britain. And I thought this was a nice opportunity to just share a new name for a lot of people who may not have known. So you can take it on yourselves to do a little bit more of a Google and find out um about Doctor Moody and I just wanted to present this as well. So one way that we try to foster inclusivity is through diversifying curriculum right now, I can't plug this too much, but at Nottingham uh II facilitate this tropical medicine and beyond module. And the reason why I wanted to mention it here is because of the indigenous communities um and the refugees and the impact on social and political issues within healthcare systems. One of the best things about this is we're able to visit er an indigenous hospital and we had those discussions with, with the local people and with the doctors who are facilitating what uptake of um the COVID vaccine was like the fact that um polio was still quite high within these communities. Um And things like that understanding where the disparities actually are. I know a lot of the feedback that we got from this is once you're in a setting like that, once you're actually visually exposed into a different environment, some of those implicit biases will go, but also you will start to build new implicit biases. Um And it's a really interesting reflective narrative that you have to have with yourself in a situation like that because you're like, oh I've seen more. So, you know, like I'm more diverse, I've got more sort of knowledge sitting behind me. But actually at times, it can tend to um it can cloud judgment in certain ways. But what we intend to do with this is to get our student groups to pass on this information through different ways, vlogs, blogs, um lecture series, etcetera like that in order to sort of share their views and how that has influenced their clinical decision making. And if we go back to that slide that I had before, II don't think um I don't think I will go all the way all the way, actually, I will Yeah, if we go back to this here, can you imagine if you've had an experience as such, where you've been able to challenge um challenge biases, but also are exposed to new material, how that will affect patient history because something could flag up at each point within that, within this cycle. Um And actually, that would feed directly into trying to manage the individual patient and not just identifying. Oh this is the end result. I know what to do with that because that's what I was taught at university stage and go forward. So I think um the exposure is absolutely key in a, in a scenario like this. And I see that my time is pretty much coming to an end and I think I'm just gonna end it there really. So hopefully, we've gone through some of the aims of this. I wanted to highlight the importance of the early diversification of the curriculum, but also not just saying that visual representation is important but going forward to, to say to everybody, yes, it's important, but we need the context of that visual representation so that we can manifest it into a positive healthcare outcome for our patients. And I am very open to take any questions if there are any. But otherwise, thank you very much for listening. And do you want to pop back in? Yeah, I was just gonna say thank you so much, Natasha that was really engaging and informative. And I definitely enjoyed it and it made me think a lot actually. Um, I definitely got that flat foot question wrong at the beginning. So it was good to think about, um, things that we have in our heads that we don't even realize. Um, and sometimes I think it's really anyone have questions. Yes. Oh, I was just gonna say, yeah. Sometimes it's really scary when you're with a person and you have to challenge their decision. That's what's really hard. So if we can foster that challenge, like if you're able to be more confident with challenging um people within a clinical scenario, if we embed that into sort of early years and into undergraduate work, then actually it becomes so much easier later on. Sorry, go ahead. Definitely any uh questions at all before I close the session can be about anything Natasha has spoken about today. OK. It's OK. If not. Yeah. So I don't think so. Oh wait, no, just people saying thank you. So, yeah, I hope today's session was as insightful for the rest of you as well. Um So next week we have our final session of the series. Um so interethnic differences in pharmacokinetics. So um Professor Jenny will be there as well as some students who have done a really cool project with her. So if you're interested in that and how you can get involved in like student projects and like the impact of that, then definitely come along. Um Again, we have the feedback form um which will enable you to get a certificate at the end of the session. So, thank you everyone for coming um and just getting involved with all the polls and everything. Um And hopefully we'll see you next week. Thank you so much, Natasha. Thank you. Bye bye.